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??Language disorders in childhood are the most common developmental disorder. More than half of the preschool language disorders??which lead to learning disabilities and are associated with psychological problem and abnormal social behavior??will continue until school age. Early detection of language disorders is beneficial to early interventio. Early detection of language disorders can be used for dynamic monitoring and screening tool??including language-specific screening scales and developmental screening scale. There are many reasons for language disorder?? leading to different clinical manifestation. Clinicians need to diagnose through language evaluation and other medical examinations.     

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??Objective To assess the efficiency of colchicine therapy in the treatment of Chinese pediatric patients with familial Mediterranean fever??FMF??. Methods In the prospective trial??pediatric patients with proven FMF??either by Tel Hashomer criteria or by MEFV gene testing??received colchicine treatment. The following indexes and results were recorded??including the clinical manifestations and signs??CRP??ESR??MEFV sequencing results of pathogenic genes??and the dosage??effective rate and follow-up of colchicine treatment. Results Twelve children??10 diagnosed by Tel Hashomer criteria vs. 2 by MEFV sequencing?? were enrolled in the study??with the median age at diagnosis/initiation of colchicine of 8??1??10?? years. They received colchicine treatment at the dose of 0.01??0.025 mg/??kg·d??. Among them 11 completed the study??while 1??8.3%?? had anaphylaxis and quit. During a median follow-up of 11??8??38?? months??the response rate was 100%. Conclusion??Colchicine is effective in Chinese children patients with FMF??which should be given as earlier as possible to prevent the consequent damage caused by chronic inflammation.     

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??Objective To analyze characteristics of body composition and the relativity on percentage of body fat??PBF????fat mass??FM????lean mass??LM?? with the local and systemic bone mineral density??BMD?? of low weight and obese children aged from 5 to 7 years old. Methods A total of 311 children aged from 5 to 7 years old were divided into three groups according to gender and body mass index??BMI????the low weight group??the control group and the obesity group??who came to Department of Child Healthcare of Shengyang Children’s Hospital for roution physical examination from February 2010 to February 2012 were selected as the subjects of the study. The body composition were measured by dual energy X-ray absorptiometry??DEXA??. Data had been compared between groups and correlation had been analysised among PBF??FM??LM and BMD. Results In obesity group?? the LM??upper limbs??lower limbs and systemic BMD in boys were significantly higher than those in girls??P??0.05??. In control group??girls’s PBF??FM were significantly higher than boys’. LM?? upper limbs?? lower limbs and systemic BMD in girls were lower than those in boys??P??0.05??. In low weight group??when FM was controlled??there was positive correlation between LM and BMD??P??0.01??. When LM was controlled??there was positive correlation among PBF??LM and lower limbs BMD in obesity girls??P??0.05??. When FM was controlled??there was significantly positive correlation between LM and lower limbs BMD??P??0.01??. When FM was controlled??there was positive correlation between LM and lower limbs BMD in obesity boys??P??0.05????When LM was controlled??there was positive correlation among PBF??FM and truncal BMD??P??0.05??. Conclusion The proportion is different from controls in low weight and obese children?? and the contribution to BMD is different. It should not only pay attetion to the change of body weight??but also pay attetion to the changes of PBF??FM??LM in body composition??so as to promote the healthy development of the bone.     

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??Objective??To study the gender and age distribution of bone metabolic markers in healthy children and adolescents??5-14 years old??. Methods??Detailed clinical documents were collected??and morning fasting 5 mL venous blood samples were drawn from 273 cases of the healthy volunteers and healthy school children. Automatic electrochemiluminescence immunoassay analyzer was applied for the tests of bone formation markers??Procollagen type 1 nitrogenous propeptides??P1NP????Osteocalcin??OC???? and bone resorption marker??β-Cross-linked C-terminal telopeptide of type 1 collagen??β-CTx????. The bone metabolic markers were used to calculate percentile values for the 5th?? 10th?? 25th?? 50th?? 75th?? 90th?? and 95th percentiles in the 3 age groups respectively. Results??The variation trends of bone formation markers??P1NP??OC?? and bone resorption marker ??β-CTx?? in two gender groups were similar??being relatively low in preschool age and school age period??gradually increasing during preadolescence??reaching peak in adolescence and declining rapidly after adolescence. There were no significant differences in bone formation markers P1NP??P??0.404?? and OC ??P??0.766?? between male and female groups??but there was significant difference in bone resorption marker β-CTx??P??0.01??. Conclusion??There are no statistically significant differences in the serum levels of P1NP or OC between male and female groups in the bone formation markers of healthy children aged 5-14 years. There is significant difference in bone resorption marker β-CTx between the two groups??the level of the boys being higher than the girls. According to the age distribution of the reference values?? the increasing trend of bone metabolic parameters of the female group will appear 1 or 2 years earlier??the peak value being lower.     

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??Abstracts?? Objective To evaluate the nutritional status and the factors related to nutrition in children with chronic kidney disease??CKD??. To explore the biological monitoring index of nutritional status of children with CKD. Methods Totally 123 patients with CKD hospitalized in our hospital from 2009 to the end of 2011 were enrolled in this study. Another 168 healthy children were chosen as control group. The height??weight??and insulin-like growth factor binding proteins 3 ??IGFBP3?? of the two groups were measured. The median percentage of weight for age??W/A????height for age ??H/A??and weight for height ??W/H???? BMI and glomerular filtration rate ??GFR?? were also calculated. The nutritional status was assessed according to the methods recommended by American Academy of Pediatrics. The relationship between the nutritional status and GFR?? gender as well as the duration of CKD were analyzed. Nutritional knowledge questionnaire for parents of children in CKD group was taken. Results The levels of W/A in 70??56.91%???? H/A in 63??51.22%?? and W/H in 60 ??48.78%?? children with CKD were lower than that of the control group??χ2=78.676??41.853??39.281?? P=0.000???? and were positively correlated with the glomerular filtration rate ??r=0.552??0.368??0.539?? P=0.000??. The serum levels of IGFBP3 were much higher than the control’s??t=2.725?? P=0.008??. The number of overweight and obesity was 21 cases ??17.07%??. About 76.67% parents of children with CKD had no knowledge of nutrition. Conclusion Malnutrition is the common complication in CKD children.The nutritional status in CKD children is positively related to the glomerular filtration rate. Serum IGFBP3 and GFR can be the biological monitoring index of nutritional status. Obesity in CKD children can’t be ignored.It is important to guide and popularize knowledge of nutrition periodically.     

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??Objective??By analyzing the cases of accidental injuries among critically ill children in our hospital in recent years??we put forward feasible preventive measures to effectively reduce the occurrence of accidental injuries. Methods??A retrospective analysis was performed on the clinical data of children who were admitted to the PICU in our hospital from May 1??2015 to April 30??2018??the types of children with accidental injuries were analyzed??and the male-to-female ratio of the results was analyzed. Seasonal characteristics??age??and the proportion of deaths were analyzed. Results ??It was found that the top three causes of accidents in critically ill children were falling injuries??246??39.87%????traffic accidents??156??25.28%????and poisoning??57??9.23%??. The incidence of accidental injuries for boys was significantly greater than that for girls??there were 375 boys and 242 girls??the ratio being 1.55??1??severe accident injuries peaked in early childhood??1??4 years old????there was no significant difference between urban and rural areas. Conclusion??The accidental injuries in critically ill children have undergone tremendous changes. We should adopt preventive measures to reduce accidental injuries.     

Cerebrospinal fluid amino acid levels in newborn infants with intracranial hemorrhage

Cerebrospinal fluid (CSF) amino acid levels including excitatory amino acids (i.e. glutamate and aspartate) in 25 preterm and 18 full-term newborn infants with no serious disease except intracranial hemorrhage (ICH) were measured. ICH was detected in 13 preterm and six full-term infants on the basis of the clinical, lumbar puncture (LP) and cranial ultrasonography (CraUSG) findings. Twelve preterm and 12 full-term infants who were neurologically healthy comprised the control group. The mean concentration of CSF amino acids did not differ between preterm and full-term infants. The CSF concentrations of taurine, threonine, glycine, alanine, valine, isoleucine, leucine, tyrosine and phenylalanine in preterm infants, and threonine, aspartic acid and alanine in full-term infants were significantly elevated in infants with ICH. These abnormalities, especially in preterm infants, are probably related to cerebral hypoxia in CSF amino acid concentrations in newborn infants with ICH.     

足月新生儿颅内出血手术治疗及随诊分析

目的探讨新生儿颅内出血(neonatal intracranial hemorrhage,NICH)的高危因素、临床表现、手术疗效及预后,以提高认识、早诊断、早治疗。方法2012年6月至2014年7月,暨南大学第一附属医院收治的NICH足月患儿中,4例接受手术治疗并定期随诊至学龄前期。采用回顾性分析的方法,记录这4例患儿围产期相关情况、临床表现、实验室检查、手术治疗情况及预后。结果4例患儿均存在围产期相关高危因素(脐带异常、胎心下降、头盆不称、阴道试产失败转剖宫产、羊水污染等);均不以神经系统异常为首发症状。颅脑超声检查均有阳性发现,头颅CT进一步确诊了颅内出血的类型和出血量,病例1双侧侧脑室及第三脑室增宽;病例2头皮下血肿及硬膜下出血,颅骨移位;病例3硬膜外血肿;病例4脑实质内出血脑疝。3例患儿急诊行开颅血肿清除术,1例患儿保守治疗3 d后行侧脑室转孔引流术。4例患儿出院后随访至学龄前,预后均良好。结论足月儿NICH与围产期因素有关,早期临床表现缺乏特异性,建议尽早行头颅超声筛查和CT确诊,及时手术治疗可以改善预后。     

新生儿呼吸衰竭肺功能及血气分析监测的临床意义

目的　 探讨新生儿呼吸衰竭 (RF)肺功能及血气分析的特征和临床意义。 方法 　将 110例新生儿RF患儿分为 4组 ,即肺炎组 (P)、缺氧缺血性脑病组 (HIE)、胎粪吸入综合征组 (MAS)、肺透明膜病组 (RDS)。对这些患儿进行肺功能和血气分析检测 ,分析其特征和临床意义。 结果 　P组和HIE组为轻度RF ,RDS为中度RF ,MAS为重度RF。MAS组、RDS组 ,TV下降 ,RR升高 ,FRC增多 (RDS组FRC减少 ) ,Crs下降 ,Rrs增加 ;PaO2 下降 ,PaCO2 升高 ,PaO2 /FiO2 下降 ,P(A a)O2 、RI、Qs/Qt升高 ,以上指标均为显著变化 ,MAS组为各组之最 ,RDS组次之。 结论 　肺功能指标可解释与证实MAS和RDS的病理生理过程 ,与血气分析指标一样和RF的严重程度一致 ,肺功能与血气分析均可作为RF的评价指标及指导治疗 ,而且肺功能具有非损伤性 ,不受吸入氧浓度影响等特点     

颅内出血足月新生儿血清基质金属蛋白酶-9及其抑制剂水平的动态变化

目的探讨颅内出血足月新生儿血清基质金属蛋白酶(MMP)-9、基质金属蛋白酶组织因子(TIMP)-1水平动态变化及其临床意义。方法采用酶联免疫吸附试验法(ELISA)分别测定30例颅内出血患儿在生后1 d内,3、7、15天血清MMP-9、TIMP-1水平及其两者比值,并与30例健康足月新生儿进行对照比较。结果颅内出血足月新生儿血清MMP-9、TIMP-1及MMP-9/TIMP-1水平明显高于对照组(P<0.01),以出生后3 d内MMP-9、TIMP-1水平及MMP-9/TIMP-1最高,7 d后开始下降,随病情恢复其水平缓慢下降,15 d部分患儿恢复正常,但与对照组比较差异仍有统计学意义(P<0.05)。小、中、大量出血患儿血清MMP-9、TIMP-1及MMP-9/TIMP-1与对照组比较,差异均有统计学意义(P<0.01);三组间比较,差异均有统计学意义(P<0.01)。结论颅内出血足月新生儿血清MMP-9、TIMP-1及MMP-9/TIMP-1水平均明显增高,可作为判定病情和评估预后的参考指标。     

Ultrasound in the evaluation of hypoxic-ischemic injury and intracranial hemorrhage in neonates: the state of the art

The ultrasonic diagnosis of hypoxic-ischemic injury and intracranial hemorrhage in neonates is reviewed. The technical and pertinent anatomical data are presented. The need to diagnose parenchymal lesions is emphasized. A sonographic classification as well as current recommendations for evaluation of intracranial contents in neonates suspected of hypoxic-ischemic injury and/or hemorrhage are presented.     

新生儿脐血pH和BE影响因素的研究

目的通过大样本收集新生儿脐血血气,研究脐血血气统计学参考值范围与不同影响因素的相关关系。方法选择2012年5～11月广东省妇幼保健院和新会妇幼保健院产科出生的新生儿进行前瞻性研究,选取其中1rainApgar评分〉7分者的脐血血气结果进行统计分析,了解正常新生儿脐血血气的统计学参考值范围;重点分析影响新生儿脐血pH和BE的因素。结果2000例新生儿中,1min Apgar评分≤7分11例,〉7分1989例,低Apgar评分组pH〈7．2的比例为45．5％,正常Apgar评分组pH〈7．2的比例为3．5％,差异有统计学意义（P〈0．001）;1800例足月单胎、体重适于或大于胎龄新生儿中,1794例1min Apgar评分〉7分者脐血pH和BE的统计学参考值范围分别是7．34±0．14（X±1．96S）和-3．53±6．57（X±1．96s）。单因素分析显示,宫内窘迫组、妊娠期并发症组pH值均低于对照组,剖宫产组pH和BE值均高于阴道分娩组,脐带绕颈组pH值降低,双胎组BE值高于单胎组;羊水性状对pH、BE值均无影响。多因素分析显示,宫内窘迫、分娩方式均对脐血血气有影响。结论足月单胎、体重适于或大于胎龄新生儿中,1min Apgar评分〉7分者脐血pH值和BE值的统计学参考值范围分别是7．34±0．14和-3．53±6．57;Apgar评分与脐血血气分析具有一致性,但单独使用Apgar评分诊断早产儿窒息可能会增加窒息的误诊率;宫内窘迫可能会增加新生儿酸中毒的发生率,不同分娩方式对脐血血气pH、BE值均有影响。     

早产儿颅内出血继发梗阻性脑积水相关因素分析

目的探讨早产儿颅内出血后继发梗阻性脑积水的相关因素。方法将2013年6月至2014年9月住院,头颅超声示严重颅内出血(Ⅲ级及Ⅳ级)的早产儿304例,按是否继发脑积水分为脑积水组(59例)和非脑积水组(185例),分析颅内出血后继发梗阻性脑积水的相关影响因素,比较两组患儿在生后不同时间点的侧脑室增宽程度。结果单因素分析结果显示,胎龄≤32周、出生体质量1 500g、重度窒息、剖宫产、呼吸窒息综合征(RDS)、新生儿感染、心力衰竭、动脉导管未闭(PDA)、p H值≤7.2、血小板减少、凝血功能异常、Ⅲ或Ⅳ级颅内出血的比例,在脑积水与非脑积水两组之间的差异均有统计学意义(P0.05)。多因素logistic回归分析显示,p H值≤7.2、血小板减少、凝血功能异常、胎龄≤32周、重度窒息、Ⅲ或Ⅳ级颅内出血为继发梗阻性脑积水的独立危险因素(OR:1.76~20.46,P0.05)。出生后各时间点,脑积水组侧脑室的后角比值均大于非脑积水组,差异有统计学意义(P均0.05);脑积水组左侧和右侧脑室的后角比值随时间变化的差异均有统计学意义(P均=0.000),均在第14天时逐渐增大,第28天达到高峰。结论重视颅内出血后继发梗阻性脑积水的高危因素,对严重颅内出血患儿定期行头颅超声动态监测脑室增宽情况。     

Electrical brain activity in preterm infants at risk for intracranial hemorrhage

van de Bor M, van Dijk JG, van Bel F, Brouwer OF, van Sweden B. Electrical brain activity in preterm infants at risk for intracranial hemorrhage. Acta Pædiatr 1994;83:588–95. Stockholm. ISSN 0803–5253
We studied the effect of preterm birth on electroencephalographic background activity in 20 infants < 32 weeks' gestation. Six infants developed periventricular-intraventricular hemorrhage during the study period. Four-channel 24-h cassette recordings were obtained on day 1,3–5 and 7–9. For each of the 24-h recordings, the percentage of the time showing stage I (continuous activity), stage II (mixed activity) and stage III (discontinuous activity) epochs was calculated. In infants without periventricular-intraventricular hemorrhage, a positive linear relationship between gestational age and continuous activity and a negative linear relationship between gestational age and discontinuous activity existed in the first day recordings; in infants with periventricular-intraventricular hemorrhage, such relationships were not found. TO determine if the changes in continuous and discontinuous activities during the first week of extrauterine life were different from the expected changes during a corresponding time in utero, we calculated the expected amounts of stage I and III changes for each infant. The actual changes were not significantly different from the expected values in both study groups. However, during the onset and/or extension of periventricutar-intraventricular hemorrhage, depression of the electroencephalographic background activity was found.